Neuroma of the common bile duct: a rare cause of jaundice

We report a case of neuroma of the main bile duct arising twenty years after cholecystectomy. The patient, a 82-year-old woman, was admitted for jaundice. Endoscopic retrograde cholangiography showed a regular stenosis of the main bile duct. Histologic examination demonstrated neuroma. Based on the analysis of this and 15 other previously published cases, the following features of bile duct neuroma were outlined: a) variable interval between cholecystectomy and the onset of jaundice (6 months to 35 years); b) the generally complicated postoperative course, c) the various localizations on the biliary tree (cystic, main bile duct, intrahepatic bile duct) and, d) the circumstances of onset.     

Mirizzi syndrome: a rare cause of obstructive jaundice

Mirizzi syndrome is an uncommon cause of extra-hepatic obstructive jaundice. Gall stones impacted at the neck of gall bladder, causing compression in the common hepatic duct (CHD) was diagnosed on endoscopic retrograde cholangio pancreaticography (ERCP). There was necrosis of the septum between the CHD and gall bladder neck, which was seen at surgery. Cholecystectomy and serosal patch of gall bladder to cover the CHD defect was performed. Patient's management and review of the literature is discussed.     

Mirizzi syndrome: A rare cause of obstructive jaundice.

Mirizzi syndrome is a rare cause of bile duct obstruction secondary to extrinsic compression of the hepatic duct by stones impacted in the cystic duct or infundibulum of the gallbladder. The suspicion of Mirizzi syndrome primarily relies on radiographic means such as ultrasound, computed tomography and cholangiography. The recognition of this rare syndrome is crucial in developing the proper treatment approach. We present 3 cases of Mirizzi syndrome and a review of the literature pertaining to the diagnosis and treatment of this rare cause of obstructive jaundice.     

Pancreatic tuberculosis: a rare cause of pseudoneoplastic obstructive jaundice

Isolated pancreatic tuberculosis is rare, and can mimic pancreatic carcinoma. We report a case of pseudoneoplastic pancreatic tuberculosis revealed by an obstructive jaundice in a 35-Year-old man. Surgical pancreatic histopathology showed a caseating granulomatous inflammation and diagnosis was confirmed by detection of Mycobacterium tuberculosis DNA using specific polymerase chain reaction-based assay (PCR). The patient was successfully treated with quadruple antituberculous therapy. In the context of the diagnostic work-up of a hypodense pancreatic mass, the diagnosis of tuberculosis relies on the presence of pancreatic caseating granulomas, that can be obtained by endosonography-guided biopsy, thus avoiding laparotomy.     

Transpapillary bile duct endoprostheses in obstructive jaundice

12 patients were treated with endoscopic transpapillary biliary endoprosthesis. The indication for biliary drainage was malignant obstructive jaundice in 10 and benign obstructive jaundice in 2 cases. The effectiveness of drainage is indicated by the disappearance of jaundice. The lifetime of the endoprosthesis was maximal 4 months and the survival of the tumor patients maximal 6 months. If the endoprosthesis is occluded replacement by a new one is necessary. Nonsurgical biliary drainage is an alternative method to palliative operation and should be preferred in general inoperability and in patients with irresectable tumors.     

Double-barrel common bile duct: a rare cause of extrahepatic biliary obstruction.

Double-barrel common bile duct is rare. We report a 50-year-old woman with defective canalization of the common bile duct, presenting with extrahepatic biliary obstruction due to stones in one compartment. CT scan highlighted this anomaly. After failed attempts at stone extraction at ERCP, she was successfully operated on.     

Malignant carcinoid tumor of the cystic duct:a rare cause of bile duct obstruction

BACKGROUND:Carcinoid tumors of the extrahepatic biliary tree are extremely rare malignancies,accounting for 0.2%-2%of all gastrointestinal carcinoid tumors,while carcinoids of the cystic duct are an uncommon entity and an extremely unusual cause of bile duct obstruction.METHODS:After an extensive literature review,we retrospectively analysed 61 cases of carcinoid tumor of the biliary tree as well as one additional case of a 60-yearold female with symptoms and laboratory/imaging examination findings compatib...     

Neuromas of the extrahepatic bile ducts as a cause of obstructive jaundice

We present four cases of extrahepatic bile duct neuromas causing obstructive jaundice. Two patients with neuromas localized in the hepatic duct had no evidence of gallstones or history of previous surgery. In these subjects, partial resection of the common bile duct and cholecystectomy was followed by hepatico-jejunostomy with Roux-en-Y reconstruction. In another patient, 7 years after cholecystectomy, a neuroma localized in the hepatic duct was treated by insertion of a T-tube. In the fourth patient, 9 years after laparoscopic cholecystectomy, partial common bile duct resection and Roux-en-Y hepatico-jejunostomy was performed. In all cases, the correct diagnosis of this very rare cause of extrahepatic bile duct obstruction was established postoperatively.     

Primary adenomyomatosis of the choledochus as a rare cause of obstructive jaundice

A 75-year-old man was hospitalized with marked signs of extrahepatic obstructive jaundice. On the basis of morphological criteria the uncommon diagnosis of primary adenomyosis of the common bile duct was made using sonography and established histologically after endoscopic sphincterotomy. The symptoms were therefore promptly to be controlled. Primary adenomyosis should be considered in the differential diagnosis of any aetiologically unexplained extrahepatic cholestasis.     

Metastatic melanoma to the common bile duct causing obstructive jaundice： A case report

Metastatic melanoma to the common bile duct is very rare with only 18 cases reported so far. We report a 46 year old women who, 18 mo after excision of a skin melanoma, developped a painless progressive obstructive jaundice. At operation a melanoma within the distal third of the common bile duct was found. There were no other secondaries within the abdomen. The common bile duct, including the tumor, was resected and anastomosed with Roux-en-Y jejunal limb. The patient survived 31 mo without any sign of local recurrence and was submitted to three other operations for axillar and brain secondaries, from which she finally died. Radical resection of metastatic melanoma to the common bile duct may result in lifelong relief of obstructive jaundice. It is safe and relatively easy to perform. In other cases, a less aggressive approach, stenting or bypass procedures, should be adopted.     

Gossypibomas as a rare cause of common bile duct dilation

正Gossypibomas are any foreign bodies left inside the patient after an operation. It represents a diagnostic challenge in clinical practice because the clinical consequence may manifest in different forms immediately, months, or even years after the surgical procedure. For this reason we believe that it is worth reporting our case which was primarily diagnosed via endoscopic ultrasonography (EUS) and then treated endoscopically.     

Eosinophilic cholangitis with obstructive jaundice mimicking bile duct carcinoma

A 55-year-old male who presented with obstructive jaundice and radiographically documented extrahepatic biliary tract obstruction is reported. Eosinophilic infiltration of the gallbladder, common bile duct, intrahepatic bile ducts, and bone marrow was observed. Eosinophilic cholangitis, a rare inflammatory condition that clinically resembles a biliary malignancy, should be taken into consideration in the differential diagnosis in the evaluation of presumed neoplasm of the bile ducts.